Fluid skin treatment systems and methods

ABSTRACT

Devices and methods for dermatology and more particularly to fluid enhanced skin treatment system for skin rejuvenation that can use an abrasive probe for removing epidermal layers while contemporaneously providing for the infusion of therapeutic fluids into the skin.

RELATED APPLICATION

This application is a non-provisional of U.S. Provisional ApplicationNo. 62/489,461 filed Apr. 25, 2017, the entirety of which isincorporated by reference.

FIELD OF THE INVENTION

The present invention relates to devices for dermatology and moreparticularly to fluid enhanced skin treatment system for skinrejuvenation that can optionally use an abrasive probe for removingepidermal layers while contemporaneously providing for the infusion oftherapeutic fluids into the skin.

BACKGROUND OF THE INVENTION

Dermatologists and plastic surgeons have used various methods forremoving superficial skin layers to cause the growth of new skin layers(i.e., commonly described as skin resurfacing techniques) since theearly 1900's. Early skin resurfacing treatments used an acid such asphenol to etch away surface layers of a patient's skin that containeddamage to thereafter be replaced by new skin. The term damage whenreferring to a skin disorder is herein defined as any cutaneous defect,e.g., including but not limited to rhytides, hyperpigmentation, acnescars, solar elastosis, other dyschromias, stria distensae, seborrheicdermatitus.

Following the removal of surface skin layers at a particular depth, nomatter the method of skin removal, the body's natural wound-healingresponse begins to regenerate the epidermis and underlying wounded skinlayers. The new skin layer will then cytologically and architecturallyresemble a younger and more normal skin. The range of resurfacingtreatments can be divided generally into three categories based on thedepth of the skin removal and wound: (i) superficial exfoliations orpeels extending into the epidermis, (ii) medium-depth resurfacingtreatments extending into the papillary dermis, and (iii) deepresurfacing treatments that remove tissue to the depth of the reticulardermis.

Modern techniques for skin layer removal include: CO2 laser resurfacingwhich falls into the category of a deep resurfacing treatment; Erbiumlaser resurfacing which generally is considered a medium-depthtreatment; mechanical dermabrasion using high-speed abrasive wheelswhich results in a medium-depth or deep resurfacing treatment; andchemical peels which may range from a superficial to a deep resurfacingtreatment, depending on the treatment parameters. A recent treatment,generally called micro-dermabrasion, has been developed that uses anair-pressure source to deliver abrasive particles directly against apatient's skin at high-velocities to abrade away skin layers. Such amicro-dermabrasion modality may be likened to sandblasting albeit atvelocities that do no cause excess pain and discomfort to the patient.Micro-dermabrasion as currently practiced falls into the category of asuperficial resurfacing treatment.

A superficial exfoliation, peel or abrasion removes some or all of theepidermis may be suited for treating very light rhytides. Such asuperficial exfoliation is not effective in treating many forms ofdamage to skin. A medium-depth resurfacing treatment that extends intothe papillary dermis can treat many types of damage to skin. Deepresurfacing treatments, such as CO2 laser treatments, that extend wellinto the reticular dermis causes the most significant growth of new skinlayers but carry the risk of scarring unless carefully controlled.

It is useful to briefly explain the body's mechanism of actuallyresurfacing skin in response to the removal of a significant depth ofdermal layers. Each of the above-listed depths of treatment disrupts theepidermal barrier, or a deeper dermal barrier (papillary or reticular),which initiates varied levels of the body's wound-healing response. Asuperficial skin layer removal typically causes a limited wound-healingresponse, including a transient inflammatory response and limitedcollagen synthesis within the dermis. In a medium-depth or a deeptreatment, the initial inflammatory stage leads to hemostasis through anactivated coagulation cascade. Chemotactic factors and fibrin lysisproducts cause neutrophils and monocytes to appear at the site of thewound. The neutrophils sterilize the wound site and the monocytesconvert to macrophages and elaborate growth factors which initiate thenext phase of the body's wound-healing response involving granulartissue formation. In this phase, fibroblasts generate a newextracellular matrix, particularly in the papillary and reticulardermis, which is sustained by angiogenesis and protected anteriorly bythe reforming epithelial layer. The new extracellular matrix is largelycomposed of collagen fibers (particularly Types I and III) which arelaid down in compact parallel arrays. It is largely the collagen fibersthat provide the structural integrity of the new skin—and contribute tothe appearance of youthful skin.

All of the prevalent types of skin damage (rhytides, solar elastosiseffects, hyperpigmentation, acne scars, dyschromias, melasma, striadistensae) manifest common histologic and ultrastructuralcharacteristics, which in particular include disorganized and thinnercollagen aggregates, abnormalities in elastic fibers, and abnormalfibroblasts, melanocytes and keratinocytes that disrupt the normalarchitecture of the dermal layers. It is well recognized that there willbe a clinical improvement in the condition and appearance of a patient'sskin when a more normal architecture is regenerated by the body'swound-healing response. Of most significance to a clinical improvementis skin is the creation of denser parallel collagen aggregates withdecreased periodicity (spacing between fibrils). The body'swound-healing response is responsible for synthesis of these collagenaggregates. In addition to the body's natural wound healing response,adjunct pharmaceutical treatments that are administered concurrent with,or following, a skin exfoliations can enhance the development ofcollagen aggregates to provide a more normal dermal architecture in theskin—the result being a more youthful appearing skin.

The deeper skin resurfacing treatments, such as laser ablation, chemicalpeels and mechanical dermabrasion have drawbacks. The treatments arebest used for treatments of a patient's face and may not be suited fortreating other portions of a patient's body. For example, laserresurfacing of a patient's neck or decolletage may result inpost-treatment pigmentation disorders. All the deep resurfacingtreatments are expensive, require anesthetics, and must be performed ina clinical setting. Perhaps, the most significant disadvantage to deepresurfacing treatments relates to the post-treatment recovery period. Itmay require up to several weeks or even months to fully recover and toallow the skin the form a new epidermal layer. During a period rangingfrom a few weeks to several weeks after a deep resurfacing treatment,the patient typically must wear heavy make-up to cover redness thusmaking the treatment acceptable only to women.

Conventional dry microdermabrasion uses a hand-held device to jet dryabrasive particles against the skin to remove cells from the epidermisto provide a younger and healthier looking appearance, remove wrinklesand improve skin tone. The superficial treatment offered by drymicrodermabrasion has the advantages of being performed withoutanesthetics and requiring no extended post-treatment recovery period.However, such dry microdermabrasion systems do not treat deep wrinklesand dehydrates the patient's skin.

SUMMARY OF THE INVENTION

The fluid skin treatment systems and methods corresponding to theinvention relate in general to the field of skin care, and the systemsmay be used by an individual to treat his or her own skin or can be usedby a practitioner to treat a patient's skin. The systems may be used toperform dermabrasion, skin rejuvenation, cleansing and the infusion oftreatment fluids into the skin.

In one variation, the system provides new modalities of fluid enhanceddermabrasion which improve upon the devices and methods disclosed by theauthor in U.S. Pat. Nos. 6,641,591; 7,678,120; 7,789,886, 8,066,716 and8,337,513, all of which are incorporated herein by this reference. Afluid enhanced microdermabrasion system includes a probe with anabrasive skin-contact surface, a negative pressure source and atreatment fluid source both in communication with the skin-contactsurface. The operator translates the abrasive skin-contact surface overthe patient's skin to remove an epidermal layer, and the negativepressure source suctions the skin-contact surface against the skin whileat the same time drawing the treatment fluid from a source to theabraded skin surface. A combination of surface features of theskin-contact surface and the negative pressure allows the treatmentfluid to penetrate surface skin layers. Such a fluid-assistedmicrodermabrasion treatment can remove visible lines and allow forimproved absorption of topical skin treatment products.

There remains a need for a skin treatment system that can effectivelyrejuvenate a patient's skin, that can optionally use abrasives forremoving epidermal layers and that provides an effective means for theinfusion of therapeutic fluids into the skin. Further, there is a needfor a system that allows for use by aestheticians in an office settingand for use at home by the patient.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an embodiment of the treatment device inuse being held by a human hand in relation to a patient's skin.

FIG. 2 is a perspective view of a working end of a device similar tothat of FIG. 1 showing the location and orientation of linear actuators,fluid inflow ports and a central suction passageway in the working end.

FIG. 3 is a sectional view of a working end similar to that of FIG. 2showing the orientation of linear actuators, fluid inflow ports and acentral suction passageway.

FIG. 4A is an illustration of a vibration device comprising an eccentricrotating mass (ERM) motor.

FIG. 4B is an illustration of a vibration device comprising a linearresonant actuator (LRA).

FIG. 5A is a front elevation view of the working end of FIG. 2 againshowing the location and orientation of linear actuators, fluid inflowports and a central suction passageway in the working end.

FIG. 5B is a front elevation view of another variation of a working endsimilar to that of FIG. 5A showing the location and orientation oflinear actuators, fluid inflow ports and a central suction passageway.

FIG. 5C is a front elevation view of another variation of a working endshowing the location and orientation of linear actuators, fluid inflowports and a central suction passageway.

FIG. 6A is a perspective view of another variation of working end withthe linear actuators configured to impart vibrational mechanical energylongitudinally relative to the longitudinal axis of the device shaft.

FIG. 6B is a perspective view of another embodiment of the skintreatment device and linear actuators in use being held by a human handin relation to a patient's skin.

FIG. 7A is a sectional view of an initial step of using the working endof FIG. 6A to treat a patient's skin.

FIG. 7B is a sectional view similar to FIG. 7A showing subsequent stepof actuating the negative pressure source, the fluid source and thelinear actuators to treat the patient's skin.

FIG. 8 is a sectional view of another variation of working end withmultiple linear actuators configured to selectively impart vibrationalenergy to skin in a first axis and/or a second axis.

FIG. 9 is a sectional view of another variation of working end with afluid trap and fluid recirculation mechanism.

FIG. 10 is a perspective view of another variation of working end thatincludes a microfabricated microfluidic elastomer block with integratedchannels for fluid flows and further configured with elastomericactuators for treating a patient's skin.

FIG. 11A is a sectional view of the working end of FIG. 10 in a firstposition showing fluid inflow channels and the suction channels with theelastomeric actuators in a repose or non-actuated position.

FIG. 11B is a sectional view as in FIG. 11A in a second position showingthe elastomeric actuators in an actuated position.

FIG. 12A is a sectional view of a working end similar to that of FIGS.11A-11B with a microfabricated elastomeric valve operated by acontroller to control fluid inflows, with the valve in a normally openposition.

FIG. 12B is a sectional view of the working end of FIG. 11A with thevalve in a closed position.

FIG. 13A is a schematic view of another variation of a working end witha floating component for maximizing the delivery of vibrational forcesto a patient's skin.

FIG. 13B is an end view of the working end of FIG. 13A.

FIG. 14A illustrates a working end of another variation of a skintreatment system that includes a single use distal tip that can beactuated by a motor drive and further includes fluid inflow and fluidoutflow components.

FIG. 14B is another view of the working end of FIG. 14A from a differentangle.

FIG. 15 is an exploded view of the working end of FIGS. 14A-14B.

FIG. 16 is another exploded view of the working end of FIGS. 14A-14B.

FIG. 17 is an end view of the distal tip of the working end of FIGS.14A-14B.

FIG. 18 is an enlarged view of a portion of the distal tip of FIG. 17.

FIG. 19A is an end view of an alternative distal tip of a working endthat can be fitted to the housing of FIGS. 14A-14B.

FIG. 19B is an enlarged view of a portion of the distal tip of FIG. 19A.

FIG. 20 is another end view of the distal tip of FIGS. 14A-14B.

FIG. 21 is a sectional view of the working end of FIGS. 14A-14B.

FIG. 22 is another sectional view of the working end of FIGS. 14A-14Brotated 90° from the view of FIG. 21.

FIG. 23 is a perspective view of another variation of a skin treatmentsystem that comprises a hand-held device with a single use distal tipwherein the handpiece alone carries a fluid source, a motor drive foractuating the working end, a pump source for negative pressure and abattery/accumulator cell as a power source.

FIG. 24 is a perspective view of the hand-held system of FIG. 23 from adifferent angle illustrates another.

FIG. 25 is a perspective view of an alterative hand-held system whichagain carries a fluid source, a pump source for negative pressure and abattery/accumulator cell as a power source, but includes actuators foractuating the skin interface.

DETAILED DESCRIPTION OF THE INVENTION

FIGS. 1 and 2 illustrate an embodiment of the invention wherein thefluid skin treatment system 50 includes a treatment device 100comprising a hand-held unit with an elongated shaft or body 105 that canbe gripped by the operator's hand and a working end or applicator tipportion 110 with a skin contact surface 122 configured to engage apatient's skin 124 (FIG. 1). The body 105 can have any suitabledimension along axis 111 and any shape suited for gripping with a humanhand or fingers, and the surface area of the skin contact surface 122can range from about 20 mm2 to 100 cm2. Devices with smaller dimensionskin contact surfaces 122 are suited for treating facial skin, and thelarger skin contact surfaces 122 are adapted for treating a patient'storso, arms or legs. In one variation described below, a practitionermay use a large surface area device (see, e.g., FIG. 6B) to treat a skinof a patient's arms, legs, torso or back in a form of fluid infusioninto the epidermis, skin cleansing or a chemo-detoxification therapy.

The components of device 100 as can be understood from FIGS. 1-3 includethe device body 105 being fabricated of a molded plastic, metal, acombination of plastic and metal or other suitable materials. The body105 can be disposable or re-useable, or can be a combination ofdisposable and non-disposable components. In the illustrated variations,the working end or applicator tip portion 110 is detachable from thedevice body 105 and can be coupled to the body 105 by a slip fit orfriction fit with or without an o-ring 128 as can be understood fromFIG. 3. Any means of detachably coupling the applicator tip 110 to thebody 105 may be suitable, such as screw thread or quick-connect typefittings. In one variation, the applicator tip 110 is a substantiallyrigid plastic material and can be disposable. In another variation, thetip 110 is configured with at least the skin contact surface 122comprising a soft silicone or other rubber-like material that can flexand/or compress slightly when engaging a patient's skin as will bedescribed below.

Now referring to FIGS. 1-3, it can be seen that the system 50 includes anegative pressure source 140 that communicates with an aspirationchannel 142 in the device 100 that terminates distally in an opening 144in the skin contact surface 122. In the variation of FIG. 2, theaspiration channel 142 terminates in opening 144 in the center of skincontact surface 122, but it should be appreciated that the opening 144can be singular or multiple and can be located or distributed anywherein the skin contact surface 122.

The system 50 further includes a fluid source 145 that communicates withat least one flow channel 146 in the device body 110 which extendthrough the applicator tip 110 and terminate in a plurality of ports 148in the skin contact surface 122 (FIG. 2). As can be seen in FIG. 2, theports 148 are distributed around an outer perimeter of the skin contactsurface 122. In this variation, the skin contact surface 122 is concavewhich is adapted for suctioning tissue into the concavity of theapplicator tip 110. In one variation, the skin contact surface 122 cancarry abrasive elements, such as diamond particles 132 embedded into thesurface 122. One or more such tips 110 with abrasives can be used duringa treatment of a patient's skin, with different size diamond particlesin different tips for more aggressive and less aggressive dermabrasion.In a method of making an applicator tip 110, such a tip can be injectionmolded of a rigid plastic. Thereafter, the skin contact surface 122 canbe heated to be slightly melted and then impressed within a form againstdiamond particles 132 which then can be somewhat embedded in the skincontact surface 122 as the plastic cools and resets. In anothervariation method of making an applicator tip 110, the skin contactsurface 122 can be an elastomer (e.g., silicone) which can be moldedinto a form that carries the diamond particles will then be bonded tothe surface 122. In another method, the diamond particles can be mixedwith a polymer or elastomer and following a molding process, a thinlayer of the polymer or elastomer can be removed (by chemical etching,sand blasting, etc) to expose the diamond particles. In another method,the diamond particles can be bonded to a molded applicator tip 110 withadhesives or bonding agents.

FIG. 1 shows the fluid source 145 being remote from the handheld device100, but it should be appreciated that the device body 105 can bedimensioned to carry a cartridge fluid source indicated at 148 in FIG.1.

In FIG. 1, it can be seen about the plane of the skin contact surface122 is angled about 30 to 45° from the longitudinal axis 111 of the body105. It should be appreciated that the plane of the skin contact surface122 can vary from about 45° to 90° from said axis 111. For convenience,FIGS. 2-3 show the skin contact surface 122 as being perpendicular tothe axis 111.

In the variation in FIG. 3, it can be seen that the skin contact surface122 in configured with a plurality of annular ridges 149 a and recesses149 b which are adapted for engaging and tensioning the patient's skinunder when the device is used to abrade skin, as disclosed in theauthor's previous patents, for example, U.S. Pat. No. 6,641,591. Theridges may be provided with sharp edges or abrasive diamond particles132 or other abrasive elements for abrading skin.

Referring to FIGS. 1-3, the system 50 further includes an electricalsource 150 and controller 155 for actuating a mechanism to impartvibratory forces from the skin contact surface 122 to the patient'sskin. In FIGS. 2-3, a device 100 corresponding to the invention includesthe distal portion 170 of body 105 carrying at least one linear actuatoror linear resonant actuator 175 which is adapted to provide mechanicalvibratory force in a particular ‘single’ direction (or vector). In FIG.2, the body 105 carries two actuators 175 which are configured toproduce vibratory motion as shown by arrows AA that is perpendicular tothe plane of the skin contact surface 122. The variations of FIGS. 2 and3 shows first and second linear resonant actuators (LRAs) 175 carriedwithin non-disposable body 105 closely adjacent to the disposableapplicator tip 110 so that vibratory forces are transmitted directly tothe applicator tip 110 and skin contact surface without any significantenergy losses. To enhance coupling of vibratory forces between thedevice body 105 and the applicator tip 110, that can be engagementfeatures such as keys, pins, or cooperating male-female elements and thelike to effectively couple motion from the LRAs 175 to the skin contactsurface 122 and then to the patient's skin.

As background, the forces produced by vibration motors are actuallyvectors, with both a direction and a magnitude. In the configurations ofskin treatment devices disclosed herein corresponding to the invention,the direction of vibratory motion provide by LRAs is designed to achievecertain objectives, which can be (i) to enhance abrasion with anabrasive applicator tip 110, or (ii) to enhance fluid infusion into thepatient's skin, for example, following dermabrasion.

A typical type of vibration motor is an eccentric rotating mass (ERM)motor 176 as shown in FIG. 4A. This type of vibration motor operates ona direct current and carries an offset mass or non-symmetric mass 177attached to the motor shaft. In operation, the motor rotates theeccentric weight and the centrifugal or centripetal forces areunbalanced which causes a rapid displacement of the motor resulting inas vibration. This ERM type of motor essentially then vibrates in twodirections X and Y with no direct movement in the direction of the axisZ of the motor shaft. A ‘coin’ vibration motor works on the sameprinciple as an article ERM motor except it is flatter and compact. Theauthor believes that such ERM vibration motors would not be particularlyeffective in the present application, and therefore the use of an ERMmotor is not proposed herein for several variations of skin treatmentdevices.

With the above background in mind, the invention herein discloses theuse of linear resonant actuator or LRA 175 as shown in FIG. 4B thatallows for control of the vectors (direction and magnitude) of vibratoryforces applied to a patient's skin. Of particular interest, the LRAsproduce vibrations much differently than ERM or eccentric rotating massmotors. An LRA comprises a magnet, a spring and a voice coil that areadapted for motor displacement. The magnet is actuated by anelectromagnetic field in the voice coil, and the spring enables themagnet (that has a selected mass) to oscillate back and forth around anormal rest position maintained by the spring. Thus, it can easilyunderstood that the magnet can be restricted to move back and forthalong only one axis Z in FIG. 4B. Such an LRA is adapted to be driven byan AC drive signal. Thus, in one variation described above and shown inFIGS. 2 and 3, the LRA is mounted to generate vibratory motionsubstantially parallel to the patient's skin (and the skin contactsurface 122) in an “abrasion mode” to move the abrasive applicator tip110 across the surface of the skin. This form of motion parallel to theskin is advantageous compared the type of motion provided by a typicalERM motor that is not capable of generating vibratory forces in a singleplane.

As can be understood from FIG. 1, the device 100 and it applicator tip110 are also adapted to be manually moved or translated across thepatient's skin at the same time the LRAs provide vibratory motion. Inone variation, the device includes directions for use wherein thepractitioner is instructed to move the applicator tip 110 in directionsperpendicular to the direction of vibratory motion provided LRAs 175.Thus, the combination of manual translation and vibratory motion allowsfor very effective removal of epidermal layers. As an example, in FIG.1, the directions of vibratory motion are indicated by arrows AA, andthe direction of manual translation indicated by arrows BB.

FIGS. 5A-5B illustrate end view of other variations of skin contactsurfaces 122 with outlines of LRAs and the direction of vibratoryforces. FIG. 5A is a view of an applicator tip 110 as in FIGS. 2 and 3and shows the direction vibratory forces AA. FIG. 5B shows a variation110′ in the shape of the skin contact surface 122 and again shows thedirection of vibratory motion provided by the LRAs with arrows BBindicating the intended direction manual translation. FIG. 5C showsanother variation 110″ in which the LRA provides vibratory motion inmultiple directions perpendicular to the axis of the device and therewould not be a preferred direction of manual translation. Linearresident actuators of the type useful for the present invention can beobtained from Precision Microdrives Ltd. 105 Canterbury Court, 1 BrixtonRoad, London, SW9 6DE, United Kingdom.

Referring again to FIGS. 1-3, it can be understood further that thecontroller 155 can be configured to control the electrical source 150that drives the LRAs, while contemporaneously controlling fluid flowsfrom the fluid source 145 and the negative pressure source 140. Ingeneral, the variation shown in FIGS. 2 and 4 provides LRAs that canenhance skin abrasion with an abrasive applicator tip 110. The LRAs canprovide sonic motion which may be in the range of 50 Hz to 1000 Hz for askin abrasion mode of operation. The range of amplitude of the LRA canbe from 0.005″ to 0.25″.

Now turning to FIGS. 6A and 6B, another applicator tip variation 180 isshown which uses LRAs 175 to provide a different mode of operation. Inthe variation shown in FIG. 6A, two LRAs are oriented substantiallyparallel to the axis 111 of the device body 105, or generallyperpendicular to the skin contact surface 122. This applicator tip 180may or may not have abrasive elements in the skin contact surface 122.In this variation, the LRAs 175 are adapted to operate in an “infusionmode” to infuse fluid from fluid source 145 into the patient's skin bymeans of vibratory forces being applied substantially perpendicular to atensioned skin surface along with the fluid flows. FIG. 6B shows ahandheld device 185 with a different form factor having a much largerskin contact surface 122′ that again has at least one LRA 175 areoriented perpendicular to the skin contact surface 122′. The devices ofFIGS. 6A-6B may be used following an abrasive skin treatment whereinthese devices may be dedicated for use in enhancing fluid penetrationinto the patient's epidermis.

As can be seen in FIGS. 6A and 7A, the applicator tip again has acentral aspiration channel 142 communicating with central opening 144.In addition, the negative pressure source 140 communicates with aperipheral annular channel 188 (or set of ports). Thus, the patient'sskin can be suctioned against the skin contact surface 122 at both theperiphery and the center of the working end to capture and tension theskin surface. The central aspiration opening 144 and the peripheralaspiration channel 188 can be coupled to the same negative pressuresource 140 or the controller 155 can control valves in the aspirationchannels to modulate suction pressure in the ports 144 and 188. In onevariation, referring to FIG. 7A, the controller 155 operates the systemso that initially suction is applied through the perimeter aspirationchannel 188 to engage the skins surface as shown in FIG. 7A. Thereafter,the controller 155 actuates the negative pressure source 140 to providesuction through the central opening 144 which results in stretching theskin into the concavity of the applicator tip 110 as shown in FIG. 7B.The controller 155 then further can operate an optional valve to allowfluid to flow from fluid source 145 through ports 148 to interface withthe skin. The fluid flows can be provided by a positive pressure pump orcan be influenced by the negative pressure at the skin surface throughaspiration port 144. Finally, the controller 155 can actuate the LRAscontemporaneous with fluid flows to the skin interface, which providemechanical force to infuse fluids into the stretched and abraded skinsurface. The operator can actuate the system by a switch on thehand-held device 100 or by means of a foot switch, or another suitableswitching mechanism. Thus, in FIG. 7B can be seen by picturing motion ofthe LRA's assistant driving fluids perpendicularly into the epidermis.It is believed that they are between motion are useful for thatinfluence the epidermis, for example from 500 Hz to 4000 Hz.

It can be understood from the FIGS. 2-7B that the LRAs 175 are carriedin the device very close to the distal end of body 105 to allow thetransmission of forces directly to and through the applicator tip 180 tothe patient's skin. The device is designed so that a disposableapplicator tip 180 can be attached to body 105 so that surface 190 ofthe tip 180 interfaces with surface 192 of body 105 to allow effectiveforce transmission from the LRAs through the tip (see FIGS. 7A-7B).

In another variation shown in FIG. 8, a device body 205 can beconfigured with multiple LRAs with at least one LRA 175 oriented toprovide vibratory motion parallel to the skin surface for causingabrasion in an “abrasion mode” with at least one another LRA 175′oriented to provide vibratory motion substantially perpendicular to theskin surface to enhance fluid penetration into the patient's epidermisin an “infusion mode” as described above. In one system variation, theoperator can select activation of the skin-parallel LRA motion or theskin-perpendicular LRA motion. In another system variation, thecontroller 155 can operate each LRA in pulsed intervals ranging from 0.1seconds or more. Further, the controller 155 can be adapted to operate“abrasion mode” LRAs in a timed sequence with the “infusion mode” LRAs.The controller 155 can have presets or can be programmable to providevarious overlapping or non-overlapping abrasion and infusion modes.

FIG. 9 another embodiment another variation of an applicator tip 210that includes a fluid trap for allowing the recirculation of therapeuticfluids. The applicator tip 210 of FIG. 9 is similar to the FIG. 7A, withcentral aspiration channel 142, peripheral aspiration channel 188 and aplurality of fluid inflow channels 148 in a concavity of the tip 210.The tip 210 can be disposable, and includes an interior collectionchamber 215. As can be seen, the aspiration channel 142 extends partwaythrough the collection chamber 215 and a gap 218 in the channel allowsfluids in the outflows to separate from the aspirated gas flows. Thus,gravity will cause fluid droplets 220 to fall out of the aspirationpathway into chamber 215. The fluid droplets can pass through a filterindicated at 225 and then fall to the bottom 228 of chamber 215 and thenthrough channels 240 back in the fluid inflow channels 148. By thismeans, therapeutic fluids that were not absorbed by the patient's skinmay be re-introduced in to the interface with the skin for infusiontherein. In one variation, shown in FIG. 9, the collection chamber 215includes one-way valves 244, such as flaps in a silicone sheet 245wherein aspiration pressure from negative pressure source 140 closes thevalves 244 to prevent fluids or gas from being suctioned throughrecirculation channels 240. It can be understood that when the collectedfluid reaches a certain weight in the chamber and when the operatorintermittently stops operating the negative pressure source 140, thenthe captured fluids will fall through the one-way valves 244 into thebottom 228 of the collection chamber 215. In another variation, thecontroller 155 can intermittently turn off the negative pressure source140 which will then allow the captured fluid volume to fall through theone-way valves 244 to the bottom 228 of the collection chamber 215. Itcan be seen in FIG. 9 that the LRA's 175 can be positioned proximate tothe applicator tip 210 to provide vibratory motion as describedpreviously. It should be appreciated that the applicator tip 210 of FIG.9 can have any suitable dimensions to position the LRAs 175 into closeproximity to the skin contact surface 122.

FIGS. 10 and 11A-11B illustrate another variation of fluid-assistedmicrodermabrasion system 400 that utilizes a handheld device asdescribed above with body 405 and an applicator tip 410 that utilizes afluidic actuator instead of a linear resonant actuator or LRA 175 asdescribe above. In general, the applicator tip variations of FIGS. 10and 11A-11B again are disposable tips with a central aspiration pathwaypassageway 415, a peripheral aspiration ports 420, and the plurality offluid outflow ports 422 in the skin contact surface 424 as describedpreviously. In addition, the applicator tip 410 includes one or morefluid actuators 425 which comprise pneumatic or hydraulic expandableinterior chambers 428 that can actuate an elastomeric surface portion440 of the applicator tip 410 as shown in FIGS. 11A-11B. There may be asingle annular actuator or up to 20 or more actuators 425 in the skincontact surface 424. The actuators 425 of the type shown have “highamplitude” capabilities, when compared to amplitude of linear resonantactuators or sonic/ultrasonic skin treatment devices. Further, thefrequency of actuation can be adjustable over a very wide range, forexample from less than 1 Hz to 50 Hz or more.

Of particular interest, the applicator tip 410 comprises amicrofabricated microfluidic body which can be manufactured by “softlithography” means as is known in the art. There are several differenttechniques of microfabricating fluidic devices—all collectively known assoft lithography. For example, microtransfer molding is used wherein atransparent, elastomeric polydimethylsiloxane (PDMS) stamp has patternedrelief on its surface to generate features in the polymer. The PDMSstamp is filled with a prepolymer or ceramic precursor and placed on asubstrate. The material is cured and the stamp is removed. The techniquegenerates features as small as 250 nm. Replica molding is a similarprocess wherein a PDMS stamp is cast against a conventionally patternedmaster. A polyurethane or other polymer is then molded against thesecondary PDMS master. In this way, multiple copies can be made withoutdamaging the original master. The technique can replicate features assmall as 30 nm. Another process is known as micromolding in capillaries(MIMIC) wherein continuous channels are formed when a PDMS stamp isbrought into conformal contact with a solid substrate. Then, capillaryaction fills the channels with a polymer precursor. The polymer is curedand the stamp is removed. MIMIC can generate features down to 1 μm insize. Solvent-assisted microcontact molding (SAMIM) is also knownwherein a small amount of solvent is spread on a patterned PDMS stampand the stamp is placed on a polymer, such as photoresist. The solventswells the polymer and causes it to expand to fill the surface relief ofthe stamp. Features as small as 60 nm have been produced (see Xia andWhitesides, Annu. Rev. Mater. Sci. 1998 28:153-84).

Referring to FIG. 11A, it can be seen that the disposable softlithography applicator tip 410 includes a base portion 442 of a rigidplastic for coupling with a device body 405, and plurality ofmicrofabricated elastomer layers 444 a-444 d that include microfluidicchannels, features, and components. In this variation, there are fourelastomer layers 444 a-444 d, but it should be appreciated that therecan be from 2 to 20 or more elastomer layers. As can be seen in FIGS. 10and 11A, the applicator tip 410 has male flow connectors 446 a-446 cthat couple with flow channels 448 a-448 c in the device body 442. Forexample, male connector 446 a connects with flow channel 448 a in body405 that in turn communicates with the annular channel 450 andperipheral aspiration ports 420. FIG. 11A further shows flow channel 448a extends through the device body 405 and is operatively coupled to thenegative pressure source 140. It can be understood that annular channel450 in the fluidic tip 410 then communicates with a plurality ofperipheral aspiration ports 420.

FIGS. 11A-11B further shows that male flow connector 446 b couples withflow channel 448 b in the device body and fluid source 145 to providefluid flows to the skin contact surface 424 through outflow ports 422.Again, the male connector 446 b connects with an annular channel 460that extends around the applicator tip 410 to communicate with the ports422.

Still referring to FIGS. 11A-11B, the system 400 includes a reversiblepump system or positive and negative pressure source 470 for actuatingthe actuators 425. In one variation, the pump system 470 can be anelectro-mechanical pressure generator, such as an AC or a DC air pump.When operating to provide a vacuum or positive pressure, the source 470can generate between 1 and 14 psi of force, for example. The pump system470 can be a piston pump, or other pump type coupled to controller 155that can deliver a precise limited volume of fluid pressure to the onemore actuators 425. In FIGS. 11A-11B, the male flow connector 446 ccouples with flow channel 448 c in body 442 and pressure source 470 toprovide gas (or liquid) flows to chambers 428 of the actuators 425. Theactuation of pressure source 470 and the actuators 425 is controlled bycontroller 155, which is synchronized with activation of the negativepressure source 140 and fluid source 145. In one variation, the operatordepresses a trigger and the controller 155 activates the negativepressure source 140 to suction the patient's skin against the skincontact surface 424. The suction forces can draw fluid through ports 422to the skin interface, or the controller 155 can release the fluid fromsource 145 a selected time interval later by controlling a valve.Thereafter, the operator can depress a trigger further (or actuateanother trigger) to actuate the actuators 425. In one variation, theactuators 425 are controlled by controller 155 to operate at apredetermined frequency and amplitude. In another variation, thecontroller 155 can be configured to allow the operator to select from amultitude of actuator frequencies and amplitudes, for example on a touchscreen of the controller 155.

In use, the system 400 of FIGS. 10-11B would allow the operator tostrongly suction the patient's skin against the skin contact surface 424which will tension and stretch the engaged skin, and then the actuationof the actuators 425 will further tension and stretch the skin in thepresence

In another variation, the skin contact surface 424 can have abrasiveelements (e.g., diamond particles, and the actuation of the actuatorscan cause motion in the abrasive over the patient's skin. This can bedone in combination with a fluid infusion treatment.

FIGS. 12A-12B illustrate another soft lithography applicator tip 475that is similar to the embodiment of FIGS. 10-11B with actuators 425,fluid infusion channels 422 and aspiration channels 420 and 440. The tip475 differs in that is includes an additional feature comprising atleast one fluidic valve 480 in elastomer layers 440 a-440 e of the tip.In FIG. 12A, it ca be seen that a male flow connector 482 a couples withflow channel 482 b in the device body and communicates with pressuresource 470 operated by the controller 155 to and open and close anelastomeric valve 480. In this variation, the valve 480 opens and closesfluid flow channel 485 formed in the elastomer layers 440 c-440 d thatcommunicates with fluid source 145. More in particular, the valve 480operates by fluid (typically air) being pumped into chamber 488 bypressure source 470 which expands chamber 488 to cause elastomer wall490 of layer 440 d to impinge on and close flow channel 485 whichcommunicates with annular channel 460 and the flow ports 422 in the skincontact surface 424. FIG. 12A shows valve 480 in an open position andFIG. 12A shows valve 480 in a closed position. In can be understood thatcontroller 155 then operate the valve 480 to control delivery oftherapeutics fluids from source 145 to the skin interface in cooperationwith actuation of the actuators 425 and aspiration forces. The valve 480can be used to conserve therapeutic fluids or to only introduce fluidwhen needed and can be operated manually or by the controller 155. Asensor, such as capacitance sensor 495 shown in FIGS. 12A-12B, can becoupled to controller 155 and can sense when whether the skin interfacehas adequate or inadequate fluid flows for a particular skin treatment.An applicator tip similar to that of FIGS. 12A-2B can be configured witha plurality of valves 480 or gates to direct flows from different fluidsources can be used, and such valves and gate can allow for computercontrol all operational parameters in all the channels. It should beappreciate that other forms of valves, normally open valves, normallyclosed valves, gates, one-way valves, check valves, pressure reliefvalves, flow control mechanisms and the like can be fabricated in anapplicator tip 475 from elastomeric materials for obvious purposes ofcontrolling and modulating flows in hydraulic and/or pneumatic circuits,and such elements can be of types used in fluidic chip fabrications anddescribed in U.S. Pat. Nos. 6,951,632; 6,953,058; 6,802,342; 8,590,573;8,104,514; 7,640,947; 7,392,827 and 6,829,753 which are incorporatedherein by this reference.

FIGS. 13A-13B illustrate another variation in which a hand-held device505 has a working end 510 that again carries at least one LRA 515disposed around a central aspiration channel 518. The disposableapplicator tip 520 is fabricated of an elastomer with a skin contactsurface 522 having abrasive elements 525 disposed thereon. The LRAs 515are adapted to stretch and impart motion to the skin to skin contactsurface 522 parallel to the surface of the skin. In this variation, thedevice body 526 includes a floating body component 528 that carries theLRA's. It can be seen in FIG. 13A that soft resilient O-rings 532 carrythe floating, vibrating body component within the device body 526. Thisallows for optimal transmission of vibration forces to the skin contactsurface 522 and also prevents vibration of the device body 526.

In one variation shown in FIGS. 13A-13B, the working end carries threeLRA's 515 with fluid inflow ports 535 and the fluid outflow channel 518as described previously. In another variation, the floating bodycomponent 528 can carry first linear actuators to deliver forces forabrasion parallel to the skin and second linear actuators for to deliverforces perpendicular to the skin for fluid infusion. For example, adevice can be similar to that of FIG. 8, with two LRA's for providingthe abrasion mode, and a single LRA (e.g., a coin LRA) can be used todrive fluids into the patient's skin. In a variation, the fluidreservoir also can be carried in the handle and the user can simplysqueeze a flexible fluid reservoir to provide for fluid infusionpressure. In one variation, the aspiration source can be coupled to thehandle to make the entire system portable. In this variation, the onlyumbilical that is needed is a conduit to the negative pressure sourcewhich is configured to suction the patient's skin into the skin contactsurface.

In another variation, an ultrasound wave generator such as apiezoelectric crystal can be provided in the working end to deliverwaves at ultrasonic speeds to the skin, for example, in the range of 1Mhz to 6 Mhz. In another variation, the working end can includecomponents and electrodes for delivering electrical current to the skinof a patient. In a further variation, the working end can be providedwith a source of light energy, such as an LED or a flash lamp or deliverlight energy to the patient's skin, for example visible or infraredlight. In one variation, a UV light from an LED is provided to killbacteria. Another variation can include a plurality of microneedles inthe skin contact surface for creating microperforations in the skin, inorder to deliver fluids or electrical currents into the patient's skin.

It should be appreciated that the treatment fluids can consist of wateror an aqueous solution containing medications, peeling agents, serums,nourishing agents, botanicals, plumping agents, vitamins, hormones andthe like known for topical use.

FIGS. 14A-17 illustrate another variation of a skin treatment system600. As can be seen in FIGS. 14A-14B, a working end 605 with housing 608and a distal skin-interfacing tip or applicator tip 610 is shown with ahandle portion 612 in phantom view. The handle can be held like a pencilas shown in the embodiment of FIG. 1. The variation of FIGS. 14A-17again includes a fluid source 620, and negative pressure source 625 anda power source 630, such as an electrical source for operating anactuation mechanism in the distal tip 610 that interfaces and engages apatient's skin.

In the variation shown in FIGS. 14A-17, the fluid source 620, negativepressure source 625, and electrical source 630 can be remote from thehandle portion 612 as described in previous embodiments. In anothervariation shown below in FIGS. 23-24, it should be appreciated that afluid source 620, negative pressure source 625 and an electrical source630 can be provided within the form factor of its handpiece. Such analternative skin treatment system of FIGS. 23-24 is suited for consumeror home use.

In the system variation of FIGS. 14A-17, the mechanism that is adaptedto actuate the applicator tip 610 comprises a motor drive 640 (FIGS.15-16) which rotates first and second drive magnets 645 a and 645 babout the shaft 646 of the motor drive 640. The rotating drive magnets645 a and 645 b are carried by rotating magnet-carrying block 658 andare adapted to move or actuate third and forth actuator magnets 650 aand 650 b that engage the applicator tip 610. As can be seen best inFIG. 15 and FIG. 16, the first and second magnets 645 a, 645 b arespaced apart and offset from axis 655 of shaft 646 and can influence theactuator magnets 650 a, 650 b as the magnet-carrying block 658 rotatesabout axis 655. The actuator magnets 650 a and 650 b shown in FIGS.15-16 are also offset from axis 655 in the carried in a magnet holder660 which partially rotates or oscillates in a receiving space 664 inthe tip 610. The magnet holder 660 has a keyed central slot 667 thatreceives a keyed shaft element 670 in the applicator tip 610. Thus, canbe seen how rotation of the drive magnets 645 a, 645 b can influence,repulse and oscillate the actuator magnets 650 a, 650 b that then canmove or oscillate within the receiving space 664 and actuate the spiralelements 665 of the applicator tip 610 described below.

Now turning to FIGS. 14A and 17, the applicator tip 610 can be describedin more detail. The applicator tip 610 can be molded from a resilientplastic material with a plurality of spiral elements 665 that aredeformable and spring-like and move as shown by arrows Z in FIG. 17. Inthe variation shown in FIG. 17, the actuatable portion comprises twospiral elements 665 that extend from a more rigid periphery 668 of theapplicator tip 610 to a central shaft portion 672 that engages themagnet holder 660. Thus, it can be understood that the central shaftportion 672 of applicator tip 610 can be rotated from 10° to about 90°,which will deform, or twist, and move spiral elements as the actuatormagnets 650 a and 650 b oscillate. One advantage of the use of theelectrical motor drive 640 is that operation is effectively silent.

FIGS. 14A-14B shows that the applicator tip 610 is removable anddisposable. FIGS. 15-16 show the assembly in exploded views. In FIG. 15,the actuator magnets 650 a, 650 b can be seen in receiving space 664within the applicator tip 610. In FIG. 16, the actuator magnets 650 a,650 b are shown in an exploded view separated from the applicator tip610. FIG. 16 further shows the motor drive unit 640 separated from thehousing 608.

FIG. 17 is an enlarged view of the working end 605 showing a pluralityof spiral elements 665 that are actuated by the system. In onevariation, the applicator tip 610 comprises an injection molded plasticand can include or skin interface of a lubricious molded silicone orsimilar elastomer. In a variation shown in FIG. 18, the distal portion680 of spiral elements 665 comprise a lower durometer silicone 682 thatis embedded with diamond particles 685 for abrading the skin as thespiral elements are actuated by the motor drive.

As can be understood from the previous embodiments, the system 600 ofFIGS. 14A-17 includes fluid inflows and fluid outflows which assist in askin abrasion treatment, a deep cleansing of the patient's skin, orinfusion of fluids into the skin. FIGS. 20-22 show more details of theinflow channels and outflow channels that provide fluid flows into theskin interface. In FIG. 21, it can be seen that fluid inflow channel 690provides for fluid flows from the fluid source 620 from open channeltermination 692 in the applicator tip 610. FIG. 22 further shows a fluidoutflow channel 700 with port 702 in the tip 610 which communicates withnegative pressure source 625 and is adapted to aspirate fluid away fromthe skin interface. In FIGS. 21-22, it can further can be seen how theproximity of drive magnets 645 a, 645 b to the actuator magnets 650 a,650 b are provided.

In one variation, the handle 612 includes a slide assembly 710 (see FIG.22) that carries the drive magnets 650 a, 650 b and rotating magnetholder 658 (or the assembly of motor 640 and drive magnets) that allowsaxial movement of the slidable component or assembly 710 within handle612 and housing 608 over an amplification distance AD shown in FIG. 22.Thus, the drive magnets 645 a, 645 b can be moved relative to theactuator magnets 650 a, 650 b to adjust actuation forces. As can beeasily understood, the attraction and repulsions forces provided bydrive magnets 645 a, 645 b on the actuator magnets 650 a, 650 b isproportional to the distance AD between the drive magnets 645 a, 645 band the actuator magnets 650 a, 650 b. In one variation, the slidingmechanism can be spring-loaded to be urged toward less-amplified forceson the applicator tip 610. This embodiment then can have afinger-actuated slider in the handle 612 to move the drive magnets 645a, 645 b distally to be in close proximity to the actuator magnets 650a, 650 b, to thereby provide maximum actuation forces. FIGS. 20 and 21show the inflow channel 690 and the outflow channel 700 and openterminations 692, 702 in the perimeter of the tip 610 but it should beappreciated that the inflow and outflow channels can be positioned invarious regions of the applicator tip 610.

FIGS. 21 and 22 also illustrate a silicone seal 712 between thedisposable tip 610 and the housing 608.

In one variation, the handle 612 may have a finger actuated switch 720,similar to a joystick, that would allow multiple functions depending onmovement of the switch 720 (See FIG. 22). For example, the switch 720could be slidable in an axial direction to increase or decrease theamplitude of the force is applied to the actuator tip 610. Radiallyinward depression of the switch 720 can increase the frequency of theactuation by changing the speed of the motor drive 640. Further,movement of the switch from side to side could modulate the negativepressure (pump speed) applied through the system which would increase ordecrease fluid flows to and from the applicator tip 610. In other words,a single finger actuated switch a button on the handle can be used tomodulate three functions: amplitude of actuation, frequency ofactuation, and fluid flow through the system.

FIGS. 19A-19B show another tip 725 that can be fitted to the housing 608of FIGS. 14A-22 and cooperates with the drive magnets and actuatormagnets as described previously. In this variation, the skin interfaceagain is actuated but the surface 728 is continuous with a plurality ofprojecting elements 742 and inflow ports 744 therein for fluid inflowsto the skin. The fluid outflow port 751 for aspirating fluid from theskin interface. Such an applicator tip 725 is adapted for skin cleansingand can optionally have abrasive particles, such as diamond dust,carried by the projecting elements 742. It can be understood how thefluid inflow channel 690 and housing 608 can be coupled to a flowchannel in applicator tip 725 that communicates with microchannels 748that extend to each of the inflow ports 744 (FIG. 19B).

FIGS. 23-24 illustrate a system 750 that carries all the fluid treatmentcomponents in a handheld device or handpiece 755. The handpiece 755 ofFIGS. 23-24 can use an applicator tip 610 together with an electricmotor 780 and magnetic drive mechanism as shown in FIGS. 14A-16 with aright angle or flex-drive since the shaft of motor 780 in the handpiece755 is not aligned with the axis 785 of the rotating and actuatedmagnets in applicator tip 610.

In FIGS. 23-24, the housing of handpiece 755 carries the motor 780centrally along handle axis 790 of the handpiece. A battery 792 is alsocarried within the housing 788. A pump 794 is provided for fluid flows.A fluid source 795 is provided which can comprise a tubular fluidcartridge or a flexible thin wall packet. On the other side of the motor780, a fluid collection reservoir 800 is provided which can comprise athin-wall packet or a sponge material in chamber of the housing that isadapted to receive fluid that has circulated through the distal tip 610.In one variation, the housing can comprise sides 788 a and 788 b of thehandpiece 755 that can be separated into opposing halves to insert thefluid source packet or cartridge 795 and to remove the collectionreservoir packet 800. In other respects, the system can function asdescribed previously wherein the diaphragm pump can suction fluid fromthe fluid source 795 through the skin interface to the collectionreservoir 800.

FIG. 25 illustrates another hand-held system 810 that has a handpiece812 that carries actuators 820 in the working end 822 that functions ina similar manner as the embodiments of FIGS. 1-10 above, rather than anelectric motor as shown in the variation of FIGS. 23-24. In FIG. 25, thesingle-use disposable applicator head 825 is detachable from the 812.Solenoid actuators 820 are shown that apply actuation forces to theapplicator head 825. The applicator head 825 then can apply forces invarious directions to the patient's skin during fluid delivery asdescribed previously. The interior of the handpiece 812 carries asingle-use replaceable fluid source or canister 845 and a micropumpindicated at 848. The micropump can be a piston pump, peristaltic pump,diaphragm pump, or solenoid pump. An accumulator cell or battery unit850 is provided. The spaces in the handle on either side of the fluidsource 845 carry a flexible wall sac that functions as a fluidcollection reservoir 860. In this variation, the fluid collectionreservoir 860 is carried in the plastic disposable portion 862 of thehandpiece 812. It should be appreciated in this embodiment, any type ofactuator(s) 820 may be used such as a linear actuator, an eccentricrotating mass actuator or a piezoelectric actuator, all of which canprovide suitable actuating forces to the skin interface. This variation,the skin interface may be of the type shown in FIGS. 19A-19B.

The invention claimed is:
 1. A method of treating a skin of a patient,the method comprising: positioning a surface of a distal tip of anabrasion device against the skin of the patient, where the distal tipcomprises a plurality of spaced apart flexible elements extending on thesurface of the distal tip from a periphery of the surface towards acentral shaft portion of the surface, where the spaced apart flexibleelements include an abrasive surface; actuating the spaced apartflexible elements by rotating the central shaft portion to displace thespaced apart flexible elements such that the surface of the distal tipreciprocates in a rotational motion independently of a housing of theabrasion device to cause the abrasive surface of the distal tip toremove a surface of the skin of the patient; delivering a fluid to thesurface of the distal tip such that the fluid flows between the spacedapart flexible elements to contact the skin of the patient; providing anegative pressure between the spaced apart flexible elements to aspiratefluid and tissue away from the skin of the patient.
 2. The method ofclaim 1, where the plurality of spaced-apart flexible elements extendsoutward from a center hub of the distal tip such that the reciprocatingrotational motion of the distal tip causes the spaced apart flexibleelements to move in an arc over the skin of the patient.
 3. The methodof claim 2, where the spaced-apart flexible elements extend in a partialspiral shape outward from the center hub of the distal tip and whereactuating the spaced apart flexible elements in the reciprocatingrotational motion causes the spiral shape to deform or twist.
 4. Themethod of claim 2, where the plurality of spaced-apart flexible elementsfurther include a plurality of ports therein, where the fluid isdelivered through at least one port of the plurality of ports.
 5. Themethod of claim 4, where each port of the plurality of projectingelements is fluidly coupled to a microchannel extending within thedistal tip.
 6. The method of claim 1, where the plurality of spacedapart elements comprise a lower durometer material located at a distalend.
 7. The method of claim 1, where the distal tip comprises aplurality of actuator magnets and where actuating the spaced apartflexible elements comprises rotating a plurality of drive magnets tocause the plurality of actuator magnets to cause reciprocatingrotational motion of the surface of the distal tip where the pluralityof drive magnets and the plurality of actuator magnets are offset from acentral axis of the central portion.
 8. The method of claim 7, furthercomprising adjusting a distance between the actuator magnets and thedrive magnets to increase an actuation force applied during actuatingthe spaced apart flexible elements.
 9. The method of claim 7, whereinthe abrasion device comprises a switch located on a body, the methodfurther comprising using the switch to adjust either: an actuation forceapplied during actuating the spaced apart flexible elements; a frequencyof the actuation of the spaced apart flexible elements; and/or deliveryof the fluid to the surface of the distal tip.
 10. A method of treatinga skin of a patient, the method comprising: positioning a surface of adistal tip of an abrasion device against the skin of the patient, wherethe distal tip comprises a plurality of spaced apart flexible elementsextending on the surface of the distal tip, where the spaced apartflexible elements include an abrasive surface; actuating the spacedapart flexible elements such that the surface of the distal tipreciprocates in a rotational motion to cause the abrasive surface of thedistal tip to remove a surface of the skin of the patient; where thedistal tip comprises a plurality of actuator magnets and where actuatingthe spaced apart flexible elements comprises rotating a plurality ofdrive magnets to cause the plurality of actuator magnets to causereciprocating rotational motion of the surface of the distal tip wherethe plurality of drive magnets and the plurality of actuator magnets areoffset from a central axis of the central portion delivering a fluid tothe surface of the distal tip such that the fluid flows between thespaced apart flexible elements to contact the skin of the patient;providing a negative pressure between the spaced apart flexible elementsto aspirate fluid and tissue away from the skin of the patient.
 11. Themethod of claim 10, further comprising adjusting a distance between theactuator magnets and the drive magnets to increase an actuation forceapplied during actuating the spaced apart flexible elements.
 12. Themethod of claim 10, wherein the abrasion device comprises a switchlocated on a body, the method further comprising using the switch toadjust either: an actuation force applied during actuating the spacedapart flexible elements; a frequency of the actuation of the spacedapart flexible elements; and/or delivery of the fluid to the surface ofthe distal tip.